HomeMy WebLinkAboutCHANGE OF CONTRACTOR - SUBCONTRACTOR 11-25-19PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
� � RECEIVED �(c,'�,
2300 VIRGINIA AVE 1;
FORT PIERCE, FL 34982 +.NOV 2 r,1019 'Y
tmt?0et '(772) 462-1553 FAX 462-1578 Lp0
Pe . uie Co�n
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR - Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current permit. A new permit application must also be completed with new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
coon encing any work. There is a $50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR - Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT - The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Di te: l �-2� �� Permit Number:(���
Site Address:
State License SLC License
Original GC, subcontractor or o e wilder
24�,.
`�i (IJK_ State License aqqSLC License
New GC, subcontractor
for Cancellation
Th'e undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
contrac or/subcontract ellation of permit. A permit cannot b cancelled if ork has been performed.
AwrQ• (or o er/builder) 71G G RAL CONTRACTOR (or new GC, as applicable)
VPRINT NAME ' INT NAME
State of Florida County of St. Lucie County te of Florida County of St. Lucie County
Tile following instrument was acknowledged before me this e following instrument was acknowledged before me this
(i rJ day of l�i� 20 !� by t� —day of N01,1 20-0 by
_ SrQJ who is personally known to me ZQC QM who is personally known to
or wh has produced F�as ID. me or who has produced DL_ as ID.
. A &n, m VOISIT9
Signature of Notary " Signature of 1Y'otary Date
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Revised 04/15/16 ='�. Pe;� remission # Y Pub • �(dt,�
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